Healthcare Provider Details

I. General information

NPI: 1861054298
Provider Name (Legal Business Name): MARIE C. WEIL, PSYD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2019
Last Update Date: 03/25/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E 11TH ST
SILVER CITY NM
88061-5503
US

IV. Provider business mailing address

PO BOX 922
SILVER CITY NM
88062-0922
US

V. Phone/Fax

Practice location:
  • Phone: 575-342-1236
  • Fax:
Mailing address:
  • Phone: 575-342-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARIE C WEIL
Title or Position: MEMBER
Credential: PSYD
Phone: 575-342-1236